UNITAID 2014 Offline LOI Template

UNITAID 2014 Offline LOI Template

Important:The below template may be used to prepare 2014 LOI content for submission. However, all LOIs must be submitted using the web-based submission tool described in the February 2014UNITAID Call for Letters of Intent and Submission Guidelines.LOIs submitted by email or post will not be considered.

Section 1: Proponent Details

1.1 Administrative information

Organization Legal Name: / (Max. 200 characters)
Title of Project: / (Max. 300 characters)
Primary Contact:
NOTE: for the purposes of the LOI, consortium and multi-party submissions should be represented by a single primary contact as described in the LOI Submission Instructions. / (Max. 200 characters)
Primary Contact postal address: / (Max. 300 characters)
Primary Contact E-mail address: / (Max. 200 characters)
Primary Contact telephone number: / (Max. 100 characters)

1.2 Organization Type and Legal Status

Enter the legal status and country of registration for lead organization and any other consortium members or parties. (Choose from the following options that best describe legal status for each: NGO, foundation, academic, for-profit, UN-based, or government).
Partner Name / Legal Status / Country of Registration
Choose one...NGOFoundationAcademicFor-profitGovernmentUnited Nations-based
Choose one...NGOFoundationAcademicFor-profitGovernmentUnited Nations-based
Choose one...NGOFoundationAcademicFor-profitGovernmentUnited Nations-based
Choose one...NGOFoundationAcademicFor-profitGovernmentUnited Nations-based
Choose one...NGOFoundationAcademicFor-profitGovernmentUnited Nations-based

Section 2: Project Description

Intervention summary

Please summarize the logic of your proposed interventionat the most basic level possibleaccording to the UNITAID Market Effects Framework.Please see Section 6.3 of theCall for LOIs and Submission Guidelinesfor an overview of the Framework. An example demonstrating the level of detail requiredis provided in Section 6.3, Figure 2 of the Guidelines.

(Max. 150 characters each)
1. Public health problem:
2. Commodity access issue:
3. Innovative market intervention:
4. Sustainable market effects:
5. Public health and value for money:

2.1 Public health problem and commodity access issue

Describe the public health problem and the commodity access issue being addressed by the intervention, including the extent and consequences of the commodity access issue, targetcountries and/or populations for the intervention, and rationale for choice of target countries and/or populations for the intervention.

(Max. 3500 characters)

2.2 Market Landscape

Provide a brief description of the current (pre-intervention) market landscape. This can build off landscaping efforts undertaken by UNITAID (please see but be tailored to the specific market situation in which you propose to intervene. This could include a description of market characteristics such as the pipeline of future products and supply-side and demand-side characteristics. Provide appropriate background to understand the market effects of the intervention you describe in Section 2.4 - Intervention.

(Max. 3500 characters)

2.3 Market Shortcomings and Reasons

In a manner consistent with Sections 5 and 6 of the UNITAID 2013-2016 Strategy, please describe up to five specific market shortcomings that would be addressed by the proposed intervention.

• Category: Choose one of the following from the drop-down list: (i) Availability, (ii)Affordability, (iii) Quality, (iv) Acceptability/Adaptability, or (v) Delivery. (Please see Section 5 of the UNITAID 2013-2016 Strategy for definitions of each category.)
• Market shortcoming: Describe the specific market shortcoming.
• Underlying reason(s): Describe the underlying reason for the market shortcoming that the proposed intervention would address.

Category / Market shortcoming / Underlying reason(s) for the marketshortcoming
Choose one...AvailabilityAffordabilityQualityAcceptability/AdaptabilityDelivery / (Max. 150 characters) / (Max. 250 characters)
Choose one...AvailabilityAffordabilityQualityAcceptability/AdaptabilityDelivery / (Max. 150 characters) / (Max. 250 characters)
Choose one...AvailabilityAffordabilityQualityAcceptability/AdaptabilityDelivery / (Max. 150 characters) / (Max. 250 characters)
Choose one...AvailabilityAffordabilityQualityAcceptability/AdaptabilityDelivery / (Max. 150 characters) / (Max. 250 characters)
Choose one...AvailabilityAffordabilityQualityAcceptability/AdaptabilityDelivery / (Max. 150 characters) / (Max. 250 characters)

2.4 Intervention

2.4.1 Key Characteristics of the Proposed Intervention

Product type (Please choose all that apply and describe product types as applicable)
Prevention / (Max. 350 characters)
Diagnostics / (Max. 350 characters)
Treatment / (Max. 350 characters)
Combination / (Max. 350 characters)
Value chain (Please choose all that apply)
Discovery / Pre-market / Peri-market / Post-market
Disease area (Please choose all that apply)
HIV/AIDS / TB / Malaria
Target income classification (Please choose all that apply.)
LICs / LMICs / UMICs
Activity types (Please choose all that apply)
Market intelligence / Technology transfer / Laboratory research
Clinical trials / Operational research / Service delivery/health systems
QA / Commodity purchase
Intellectual property / Product development

2.4.2 Intervention Narrative

Provide a brief description of the intervention, including (i) its key outcomes and (ii)specific rationale for how it will address the reason(s) for the market shortcomings described in Section 2.2 - Market Landscape. For each outcome, provide 2 to 3 indicators to be used to monitor achievement and describe at what stage of implementation the outcomes will be achieved. Your description must include a list of the specific countries your intervention will target. For consortium and multi-party submissions, please describe the relative roles and responsibilities of each partner.

(Max. 5000 characters)

2.5 Risks and Assumptions[1]

Describe the key assumptions underlying achievement of the project outcomes and the major risks to the intervention achieving the desired outcomes (including programmatic risks, project management risks, etc.). Where possible, give a broad indication of the likelihood and significance of the risk and any mitigation strategies to be included in the intervention.

(Max. 1750 characters)

2.6 Feasibility1

Please describe any preconditions that must be met in order to ensure (i) the timely launch of the proposed project and/or (ii) its successful implementation. How will these preconditions be met within a reasonable timeframe following approval of the proposal (i.e., 4-6 months)? Consistent with any target countries presented in 2.4.2 Intervention Narrative, please describe (i) any discussions held to date with target country stakeholders in support of the proposed intervention and (ii) how you will achieve firm commitment to collaborate from target country officials if a proposal stemming from this LOI were to receive UNITAID funding.

(Max. 1750 characters)

2.7 First-tier Prioritisation Criteria and Impact

Summarize how the expected outcomes of the intervention presented in Section 2.4 - Intervention align with UNITAID’s first-tier prioritization criteria: (i)public health effects,(ii) market effects,(iii) value for money,and(iv) innovation (please see Section 6.4 of the Call for LOIs and Submission Guidelines for definitions of the criteria).

(Max. 3000 characters)

2.8 Second-tier Prioritisation Criteria and Impact

Summarize how the expected outcomes of the intervention presented in Section 2.4 - Intervention align with UNITAID’s second-tier prioritization criteria: (i)leverage, (ii) added value, (iii), equity and (iv) ability to transition and sustainability (please see Section 6.4 of the Call for LOIs and Submission Guidelines for definitions of the criteria).

(Max. 2000 characters)

2.9 Strategic Alignment with UNITAID

Describe how the intervention is consistent with UNITAID’s business model as well as UNITAID’s overall strategy (please see Call for LOIs and Submission Guidelines and the UNITAID 2013-2016 Strategy).

Please also include an indicative breakdown of percentage spending by country income level based on World Bank income groups. Please indicate the countries to be included in the Project, highlighting the consistency with UNITAID's eligibility criteria which require that:

• At least 85% of UNITAID funds dedicated to purchase commodities be spent on low income countries (LICs);
• No more than 10% on lower middle income countries (LMICs); and
• No more than 5% on upper middle income countries (UMICs), with priority given to those with a high disease prevalence, subject to these countries providing co-financing for their projects representing 20% in year 1 and rising to 40% by the end of the project.

It should be noted that in the case of both LMICs and UMICs, UNITAID contributions should be used to scale up existing programmes targeted principally at vulnerable groups in accordance with the definition provided under “equity” in Section 6.4 of the Call for LOIs and Submission Guidelines).

(Max. 1500 characters)

2.10 Relevant Experience

Describe the relevant experience, expertise and added value that your organization brings to accomplishing the goal of the project. If the project involves a consortium, provide this information for each organization. For consortiums, also provide details on:

1. High-level roles and how the work will be divided;
2. How duplication will be avoided and how the efficiency of the consortium will improve project outcomes; and
3. Relevant experience working in a partnership (especially with any partners proposed for this project).

Describe any relevant experience your organization/consortium has had in the countries proposed in this project.

(Max. 3000 characters)

2.11 Other

Please use this field to provide any other relevant information to support the LOI.

(Max. 1500 characters)

Section 3: Budget and Finance

3.1 Project financial information

3.1.1 Estimated Project Duration

Please select number of years from drop-down menu / Choose one...1 year2 years3 years4 years5 years

3.1.2. Estimated Budget Overview:

Budget Item / Subtotal
Commodity-related Costs
(Other budget item; max. 250 characters)
(Other budget item; max. 250 characters)
(Other budget item; max. 250 characters)
(Other budget item; max. 250 characters)
(Other budget item; max. 250 characters)
Total

3.1.3 Allocation of Funds (for consortium projects only; if single entity, organization, or institution, leave blank)

Describe the approximate allocation of funds among the partners according to the relative roles and responsibilities of each partner described in 2.4.2 Intervention Narrative.

(Max. 1000 characters)

3.1.4 Co-Funding (if not applicable, leave blank)

Provide the information below for any co-funding for the project.

Organization providing
Co-funding / Project Partner receiving
Co-funding / Is Co-funding Cash or
In-kind? / Amount
(US$) / Assured or
Tentative?
Choose one...CashIn-kind / Choose one...AssuredTentative
Choose one...CashIn-kind / Choose one...AssuredTentative
Choose one...CashIn-kind / Choose one...AssuredTentative
Choose one...CashIn-kind / Choose one...AssuredTentative
Choose one...CashIn-kind / Choose one...AssuredTentative
Please describe the total amount of co-funding expected for the project and any additional information required to understand expected co-funding arrangements. How does the cofunding complement the proposed project? What period of time is covered by the cofunding?
(Max. 1000 characters)

3.2 Organizational financial information: to be completed for lead organization and, ifapplicable, all consortium members who will receive >20% of project funding.

3.2.1 Yearly Budget: (select range from pull down menu)

Enter the yearly budget of each partner organization:

• Less than US$ 5 million
• Between US$ 5 – 25 million
• Between US$ 25 – 50 million
• Between US$ 50 – 75 million
• Between US$ 75 – 100 million
• Greater than US$ 100 million

Partner Name / Yearly budget
Choose one...Less than US$ 5 millionBetween US$ 5-25 millionBetween US$ 25-50 millionBetween US$ 50-75 millionBetween US$ 75-100 millionGreater than US$ 100 million
Choose one...Less than US$ 5 millionBetween US$ 5-25 millionBetween US$ 25-50 millionBetween US$ 50-75 millionBetween US$ 75-100 millionGreater than US$ 100 million
Choose one...Less than US$ 5 millionBetween US$ 5-25 millionBetween US$ 25-50 millionBetween US$ 50-75 millionBetween US$ 75-100 millionGreater than US$ 100 million
Choose one...Less than US$ 5 millionBetween US$ 5-25 millionBetween US$ 25-50 millionBetween US$ 50-75 millionBetween US$ 75-100 millionGreater than US$ 100 million
Choose one...Less than US$ 5 millionBetween US$ 5-25 millionBetween US$ 25-50 millionBetween US$ 50-75 millionBetween US$ 75-100 millionGreater than US$ 100 million

3.2.2 Sources of Funds and Key Donors

List your organization’s sources of funds and key donors as a proportion of the yearly budget(s) described in 3.2.1 Yearly Budget.

(Max. 500 characters)

3.2.3 Audit Information

Please indicate if your organization undergoes/has undergone the following:

Statutory Audit
Regular External Audits
Donor Audit
(If yes, list donor(s); max. 500 characters)
Internal Audit Function
Please add any information on your organization’s audits that would be useful.
(Max. 750 characters)

3.2.5 Financial Statements

Are your financial statements publically available?
Yes
No

Authorised Signature

I certify that I am the authorised representative of the proponent and that the information entered in this form is true and correct, including, as applicable, any representation of the commitments or intended roles of additional consortium members or parties. I understand that false or misleading statements may provide grounds for the disqualification of this Letter of Intent.

Date: / (DD/MM/YYYY)
Place:
Full name as signature*:

*Note: Authorized signature and Submission signature need not be provided by the same individual.

Submission Signature

I certify that the information entered in this form is true and correct. I understand that false or misleading statements may provide grounds for the disqualification of this Letter of Intent.

Date: / (DD/MM/YYYY)
Place:
Full name as signature*:

*Note: Authorized signature and Submission signature need not be provided by the same individual.

Offline LOI Template; UNITAID Call for LOIs, February – May 2014 Page 1 of 13

[1]Planning/hosting a birthday party may be a useful analogy to developing/implementing an intervention in terms of distinguishing between intervention risks (2.5) and intervention preconditions (2.6). Preconditions relate to what must be done before the party(i.e., before implementing an intervention), e.g., sending invitations, baking a cake, and decorating. Risks are things that can go wrong once the party has started (i.e., after implementation of the intervention begins), e.g., the party entertainment does not arrive, inclement weather interferes, or the host runs out of refreshments.